Health inspection·May 1, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and interview, the facility failed to follow insulin administration and blood glucose monitoring per physician orders. This affected one resident (Resident #79) of three residents reviewed for insulin use. The facility census was 82. Residents Affected - Few Findings Include: Review of the medical record for Resident #79 revealed an admission date of 03/03/25. Diagnosis included type 2 diabetes, atherosclerotic heart disease of native coronary artery without angina pectoris and presence of aortocoronary bypass graft. Review of orders for March 2025 revealed Lantus (long acting insulin) insulin 42 units subcutaneous once a day started on 03/03/25, Insulin Lispro seven units three times a day before meals and per sliding scale dated 03/03/25. Review of the Minimum data Set (MDS) dated [DATE] revealed intact cognition. Resident #79 received insulin injections seven days during the assessment period. Review of medical record revealed Resident #79 was out of the facility to an endocrinology appointment on 03/26/25 at 9:00 AM. Review of the provider note dated 03/26/25 revealed continue lispro seven units before meals, two units for 50 points above 150 and lantus 42 units daily, will order freestyle libre. Review of the physician orders revealed Freestyle Libre 3 plus sensor (blood-glucose sensor) device apply once every 14 days started on 03/26/25. In addition, on 03/26/25 Insulin Lispro was discontinued, and blood sugars were not obtained. Review of the March and April 2025 Medication Administration Records (MAR) revealed Resident #79 stopped receiving Insulin Lispro routinely and as needed on 03/26/25 and monitoring blood sugars were not continued since 03/26/25. Resident #79 started the blood glucose monitor device on 03/28/25. Interview and observation on 04/28/25 at 12:07 PM with Resident #79 revealed her Freestyle Libre 3 plus sensor (glucose monitoring disc) came off and she stated she had to wait two weeks to get a new one. Resident #79 also stated staff have not been monitoring her blood sugars for some time. Observation at that time revealed Resident #79 did not have her glucose monitoring disc on. Interview on 04/30/25 at 11:42 A.M. with RN #300 from the endocrinologist's office revealed (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 366429 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366429 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare Zanesville Inc. 4200 Harrington Drive Zanesville, OH 43701 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)